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Clinical Note |

Endoscopic Management of Idiopathic Spontaneous Skull Base Fistula Through the Clivus

Hesham Abd Elrahman, MD; David Malinvaud, MD; Nicolas A. Bonfils, MD; Rabii Daoud, MD; Michael Mimoun, MD; Pierre Bonfils, MD, PhD
Arch Otolaryngol Head Neck Surg. 2009;135(3):311-315. doi:10.1001/archoto.2008.550.
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Cerebrospinal fluid (CSF) is produced by the choroid plexus of the lateral third and fourth ventricles at a rate of 0.35 mL/min. The CSF flows into the subarachnoid space and is absorbed by the arachnoid villi in the sagittal sinus. Normal CSF pressure is 5 to 15 cm H2O. Neurologic symptoms may occur when CSF pressure reaches more than 15 to 20 cm H2O.1 Three concomitant factors are needed for CSF leakage: an osseous defect, a meningeal disruption, and a pressure gradient.2

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Figure 1.

High-resolution computed tomographic scan (1-mm-thick axial section) localized at the site of the bone defect at the median part of the clivus (arrow). The right sphenoid sinus was filled with fluid.

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Figure 2.

Magnetic resonance imaging (axial T1-weighted sequence with gadolinium) showed the interruption of the sphenoidal mucosal enhancement in front of the bone defect at the medial part of the clivus (arrow). The right sphenoid sinus was filled with fluid.

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Figure 3.

High-resolution computed tomographic scan (1-mm-thick axial section) localized at the site of the bone defect at the median part of the clivus (arrow).

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Figure 4.

Postoperative magnetic resonance imaging control obtained 4 months later. The defect was effectively closed by fat tissue without evidence of leakage (arrow).

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